EVALUATION OF NON-MASS AREA IN BREAST ULTRASOUND WITH

PATHOLOGIC CORRELATION

Nawar Dheyaa Ahmed Al-Gburi, Hiba Mohammed Abdulwahid

 

Department of Radiology, College of Medicine, University of Baghdad. Baghdad, Iraq.

B

reast tumors are common in women. Breast non-mass lesions (NML) is a new term that describes breast abnormalities on ultrasound.

Purpose. To evaluate the variable imaging appearance of NMLs in breast ultrasound and its correlation with pathological results, and to provide a standardized approach to NMLs in breast ultrasound.

Materials and methods. A cross-sectional study was conducted at the Outpatient Breast Clinic of Oncology Teaching Hospital at Medical Complex in Baghdad city/Iraq for a period of ten months from 1st of June, 2024 to 31st of March, 2025, on a sample of 60 women with breast NMLs. Breast NML was characterized by an experienced breast imaging radiologist. The diagnosis of malignancy was confirmed via histopathological examination.

Results. The ultrasound BI-RADS categories of breast NMLs were BI-RADS 4A (35%), BI-RADS 4 B (51.7%), and BI-RADS 4C (13.3%). Histopathology revealed that 40% of NMLs were malignant, 15% were benign with upgrade potential (BUP), and 45% were benign tumors. The most common malignant breast non-mass lesion was ductal carcinoma in situ and the most common benign non-mass lesion was fibroadenosis. A significant association was observed between the segmental distribution of NML, associated architectural distortion, echogenic dots (microcalcification), increased vascularity, and posterior shadowing with malignancy (p≤0.05). Cystic changes in NMLs are predictive of benign lesions.

Discussion. The present study showed that the ultrasound characteristics of malignant NMLs were significantly segmental distribution, associated architectural distortion, echogenic dots, increased intralesional vascularity, and posterior shadowing (p≤0.05). These findings are consistent with the results of different studies, such as Park et al. retrospective study in South Korea and Guo et al. retrospective study in China, which documented a significant correlation between architectural distortion, microcalcification, increased vascularity, and posterior shadowing in ultrasound with malignancy of breast NMLs. In our study, a highly significant association was observed between small cystic changes on ultrasound of the breast NML and benign tumors (p<0.001). A review by Tsunoda and Moon in South Korea consistently reported that ultrasound findings of cystic changes are predictive of benign breast NML.

Conclusion. Breast non-mass lesions are a new and important descriptor in breast ultrasonography. Ultrasound characteristics of segmental distribution of breast non-mass lesions, presence of architectural distortion, echogenic dots (microcalcification), increased vascularity, and posterior shadowing are predictive of malignant breast NMLs and a high probability of malignancy with corresponding imaging correlates on mammography as asymmetry or distortion.

 

Keywords: breast NMLs, ultrasound, BI-RADS, microcalcification, architectural distortion.

 

Corresponding author: Nawar Dheyaa Ahmed Al-Gburi, e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

For citation: Nawar Dheyaa Ahmed Al-Gburi, Hiba Mohammed Abdulwahid. Evaluation of non-mass area in breast ultrasound with pathologic correlation. REJR 2025; 15(3):112-125. DOI: 10.21569/2222-7415-2025-15-3-112-125.

Received:        28.06.25 Accepted:       02.09.25